Headache research gets a boost from military interest

By gerencherk

Even though headaches are among the most common and debilitating of health problems, they don’t command much respect in the high-stakes, big-money world of medical research. That’s according to Dr. Peter Goadsby, director of the Headache Center at the University of California-San Francisco, who estimates federal research spending ranges a paltry $5 million to $13 million. But that soon may change as the Department of Defense looks for help managing returning soldiers’ post-injury headaches and as the National Institute of Neurological Disorders and Stroke (NINDS) prepares to host a summit meeting this month aimed at reinvigorating headache research.

“Headache is a really big problem in returning active-duty personnel,” Goadsby said in an interview Friday. “The military have become really interested and have gotten their act together faster than NINDS in trying to start research and understand the phenomenon better and how to treat it.”

That may end up benefiting many people, whether they have trauma-borne or other headaches.

“There are many ways in which you can end up with headache problems,” he said. “The International Headache Society classification booklet runs to 160 pages. Not a weekend read.”

More than 30 million Americans suffer from migraines, the symptoms of which can include intense throbbing on one or both sides of the head, dizziness, nausea, vomiting and extreme sensitivity to light, sound and smell.

“The most common form of disabling headache that turns up in doctors’ offices in the United States is migraine,” Goadsby said. Migraine is a form of primary headache, meaning the headache itself is the big health problem as opposed to one that stems from a different problem such as a tumor or infection.

Looking to the future

The most exciting research going on now relates to three things, Goadsby said: Genetic work that’s targeted to the many migraine sufferers who also have first-degree relatives who get migraines, brain imaging that allows scientists to better understand the mechanisms of migraine, and a pipeline of therapeutics that promise to help patients relieve migraine pain more effectively.

On the treatment front, a new DHE spray device is coming out next year, and a new class of migraine drugs called CGRP receptor antagonists are in late phase 3 clinical trials, Goadsby said.

Last week, Consumer Reports named sumitriptan, the only generic drug in a class of migraine treatment drugs called triptans, its first “best buy” drug of 2010. CR examined medical studies on sumatriptan and now recommends it for people who meet the safety criteria as a first try for therapy because CR concluded sumatriptan is less expensive than other triptans but just as effective. See my recent Vital Signs column for more on how some headache cures may make the pain worse.

Goadsby agreed that sumatriptan can be a good first-try tool to treat migraines, and that timing plays a key role.

“For most patients, they’ll do better if they treat it earlier,” he said. “A migraine affects so many people that there are lots of general rules, and people shouldn’t be surprised if they fall into an exception given how common the problem is.”

Another big issue is how to treat frequent migraines, those that occur at least 15 days a month, Goadsby said.

“Migraine has a range of manifestations, and sometimes the attacks are not so severe but very frequent and the question is how to stop them. Then triptans are not the answer to that.”

Research on a different kind of headache, cluster headaches, has seen perhaps the most advances in the last decade, though that’s coming off a low base, Goadsby cautioned.

“We’ve understood there are more women with it than we thought. A lot of women were being missed or misdiagnosed,” he said. “You can get some light sensitivity with cluster. We’ve proven with placebo-controlled trials that oxygen is effective. Two of the triptan sprays work…. The understanding and the evidence base of treatment has gone from next to nothing to really quite reasonable.”

Goadsby said he’s hopeful that the upcoming NINDS meeting on headache research, the first of its kind in about 10 years, will have ripple effects that encourage medical students to pursue a subject that’s long suffered a prestige problem.

“It’s a self-fulfilling prophecy,” he said. “It’s totally axiomatic that unless there’s some serious interest in the subject at the top level, at the leadership level, it’s never going to change at any other level. That’s why the NINDS meeting is so important.”

About Health Matters

Health Matters is a blog-style round-up of news and analysis concerning consumer health and the business of health care. The lead writer is MarketWatch reporter Kristen Gerencher, who also writes the Vital Signs column. Andrea Coombes and Jonathan Burton contribute editing. Gerencher won a 2006 explanatory journalism award from the Society of Professional Journalists-Northern California for a series she did on health savings accounts.